ORIGINAL RESEARCH Ochsner Journal 17:80–82, 2017 Ó Academic Division of Ochsner Clinic Foundation
Are Pediatricians Diagnosing Obese Children? Katharine Thomas, MSc, MD,1,2 Fernando Urrego, MD2,3 1
Department of Research, Ochsner Clinic Foundation, New Orleans, LA 2The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA 3Department of Pediatric Pulmonology, Ochsner Health Center for Children, Ochsner Clinic Foundation, New Orleans, LA
Background: Pediatric obesity is the most prevalent nutritional disorder in American children. The detrimental social, psychological, and physiological effects of obesity call for pediatricians to address this health concern. The literature demonstrates that clinicians are underreporting the diagnosis of obesity in the pediatric setting. The primary purpose of this study was to determine if pediatricians at one pediatrics clinic in the Ochsner Health System are documenting the presence of an overweight or obese body mass index (BMI) as a diagnosis in the medical record. A secondary purpose of this study was to determine the demographics of all pediatric patients in the Ochsner Health System to be used for program development. Methods: A retrospective medical record review was conducted. Records from April 1, 2012 to April 1, 2016, were reviewed for the presence of the diagnosis of BMI classified as obese or overweight. Results: We analyzed a total of 175,066 records in this study. Of these records, 1.32% documented a diagnosis of obesity, and 0.5% documented a BMI score indicating overweight. The percentages of patient visits that met the Centers for Disease Control and Prevention criteria to be classified as obese or overweight were 28.66% and 30.41%, respectively. The majority of our pediatric patients were male (51.76%), white (43.31%), and 5-12 years old (43.80%). Conclusion: This study demonstrates that pediatricians at Ochsner Health Center for Children are not diagnosing patients who have unhealthy BMI scores as overweight or obese. Interventions are needed to increase the identification of children who may benefit from receiving resources that encourage a healthy lifestyle and optimal weight maintenance. Keywords: Diagnosis, nutrition disorders, overweight, pediatric obesity, pediatrics
Address correspondence to Fernando Urrego, MD, Department of Pediatric Pulmonology, Ochsner Health Center for Children, Ochsner Clinic Foundation, 1315 Jefferson Hwy., New Orleans, LA 70121. Tel: (504) 842-3900. Email: [email protected]
INTRODUCTION Pediatric obesity is the most prevalent nutritional disorder in American children.1 Childhood obesity is defined as a body mass index (BMI) greater than the 95th percentile for age.2 The Centers for Disease Control and Prevention (CDC) demonstrated that since 1970, the rate of children who are overweight has increased 4-fold in children aged 611 years and 3-fold in those aged 12-19 years.1 Currently, the rate of obesity among pediatric patients is 16.9%.3 Obesity in childhood has been linked to the development of neurologic, cardiovascular, renal, gastrointestinal, and musculoskeletal disorders.4 In addition, children who are obese are at a greater risk of developing asthma, dyslipidemia, sleep apnea, and hypertension.4 Studies have also shown that more than half of all children with obesity have concomitant metabolic syndrome.5 Children who are obese also have a greater risk of psychological distress, depression, and social marginalization than their peers with a healthy weight.6 The detrimental social, psychological, and physiological effects of obesity call for pediatricians to address this health concern at every visit. Identification is necessary for patients 80
to receive thorough weight-loss counseling and referrals to healthy living programs. The literature demonstrates that clinicians are underreporting the diagnosis of obesity in the pediatric setting.7-9 Cook and colleagues7 conducted a national survey to examine the frequency of obesity diagnosis and diet and exercise counseling and found that obesity was diagnosed at 0.78% of all ambulatory visits and 0.93% of all well-child visits. We implemented this pilot study to determine how many pediatric patient visits at Ochsner Health Center for Children received the diagnosis of being overweight or obese. The purpose of this study was to determine if the pediatricians at one pediatrics clinic in the Ochsner Health System are documenting a BMI score indicating overweight or obeity as a diagnosis in the medical record. A secondary purpose of this study was to determine the demographics of all pediatric patients in the Ochsner Health System. This demographics information will aid in the development of a health promotion intervention geared toward our specific pediatric population. Ochsner Journal
Thomas, K Table. Documented Diagnoses of Obesity and Overweight vs Actual Diagnosis of Obese and Overweight Body Mass Index in Clinic Visits Between April 1, 2012 and April 1, 2016 Patient Visits n¼175,066 Documented diagnoses
Obese Overweight
Patients with body mass index indicating overweight or obese
METHODS We conducted a retrospective medical record review at Ochsner Health Center for Children in New Orleans, LA, a single pediatrics clinic in the Ochsner Health System. For the primary outcome, we examined records from April 1, 2012 to April 1, 2016, and reviewed each record for the presence of a BMI score classified as obese or overweight. In addition, we calculated the percentages of children who were either overweight or obese. The CDC’s BMI reference was used to define overweight and obese status.2 The CDC defines overweight as a BMI equal to or greater than the 85th percentile to the 95th percentile for children of the same age and sex and obese as a BMI greater than the 95th percentile for children of the same age and sex.2 For the secondary outcome, we examined the demographics of all pediatric patients in the Ochsner Health System. Age, race, and sex of all current patients were documented. Pediatric patients were defined as any patient
Are Pediatricians Diagnosing Obese Children? Katharine Thomas, MSc, MD,1,2 Fernando Urrego, MD2,3 1
Department of Research, Ochsner Clinic Foundation, New Orleans, LA 2The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA 3Department of Pediatric Pulmonology, Ochsner Health Center for Children, Ochsner Clinic Foundation, New Orleans, LA
Background: Pediatric obesity is the most prevalent nutritional disorder in American children. The detrimental social, psychological, and physiological effects of obesity call for pediatricians to address this health concern. The literature demonstrates that clinicians are underreporting the diagnosis of obesity in the pediatric setting. The primary purpose of this study was to determine if pediatricians at one pediatrics clinic in the Ochsner Health System are documenting the presence of an overweight or obese body mass index (BMI) as a diagnosis in the medical record. A secondary purpose of this study was to determine the demographics of all pediatric patients in the Ochsner Health System to be used for program development. Methods: A retrospective medical record review was conducted. Records from April 1, 2012 to April 1, 2016, were reviewed for the presence of the diagnosis of BMI classified as obese or overweight. Results: We analyzed a total of 175,066 records in this study. Of these records, 1.32% documented a diagnosis of obesity, and 0.5% documented a BMI score indicating overweight. The percentages of patient visits that met the Centers for Disease Control and Prevention criteria to be classified as obese or overweight were 28.66% and 30.41%, respectively. The majority of our pediatric patients were male (51.76%), white (43.31%), and 5-12 years old (43.80%). Conclusion: This study demonstrates that pediatricians at Ochsner Health Center for Children are not diagnosing patients who have unhealthy BMI scores as overweight or obese. Interventions are needed to increase the identification of children who may benefit from receiving resources that encourage a healthy lifestyle and optimal weight maintenance. Keywords: Diagnosis, nutrition disorders, overweight, pediatric obesity, pediatrics
Address correspondence to Fernando Urrego, MD, Department of Pediatric Pulmonology, Ochsner Health Center for Children, Ochsner Clinic Foundation, 1315 Jefferson Hwy., New Orleans, LA 70121. Tel: (504) 842-3900. Email: [email protected]
INTRODUCTION Pediatric obesity is the most prevalent nutritional disorder in American children.1 Childhood obesity is defined as a body mass index (BMI) greater than the 95th percentile for age.2 The Centers for Disease Control and Prevention (CDC) demonstrated that since 1970, the rate of children who are overweight has increased 4-fold in children aged 611 years and 3-fold in those aged 12-19 years.1 Currently, the rate of obesity among pediatric patients is 16.9%.3 Obesity in childhood has been linked to the development of neurologic, cardiovascular, renal, gastrointestinal, and musculoskeletal disorders.4 In addition, children who are obese are at a greater risk of developing asthma, dyslipidemia, sleep apnea, and hypertension.4 Studies have also shown that more than half of all children with obesity have concomitant metabolic syndrome.5 Children who are obese also have a greater risk of psychological distress, depression, and social marginalization than their peers with a healthy weight.6 The detrimental social, psychological, and physiological effects of obesity call for pediatricians to address this health concern at every visit. Identification is necessary for patients 80
to receive thorough weight-loss counseling and referrals to healthy living programs. The literature demonstrates that clinicians are underreporting the diagnosis of obesity in the pediatric setting.7-9 Cook and colleagues7 conducted a national survey to examine the frequency of obesity diagnosis and diet and exercise counseling and found that obesity was diagnosed at 0.78% of all ambulatory visits and 0.93% of all well-child visits. We implemented this pilot study to determine how many pediatric patient visits at Ochsner Health Center for Children received the diagnosis of being overweight or obese. The purpose of this study was to determine if the pediatricians at one pediatrics clinic in the Ochsner Health System are documenting a BMI score indicating overweight or obeity as a diagnosis in the medical record. A secondary purpose of this study was to determine the demographics of all pediatric patients in the Ochsner Health System. This demographics information will aid in the development of a health promotion intervention geared toward our specific pediatric population. Ochsner Journal
Thomas, K Table. Documented Diagnoses of Obesity and Overweight vs Actual Diagnosis of Obese and Overweight Body Mass Index in Clinic Visits Between April 1, 2012 and April 1, 2016 Patient Visits n¼175,066 Documented diagnoses
Obese Overweight
Patients with body mass index indicating overweight or obese
METHODS We conducted a retrospective medical record review at Ochsner Health Center for Children in New Orleans, LA, a single pediatrics clinic in the Ochsner Health System. For the primary outcome, we examined records from April 1, 2012 to April 1, 2016, and reviewed each record for the presence of a BMI score classified as obese or overweight. In addition, we calculated the percentages of children who were either overweight or obese. The CDC’s BMI reference was used to define overweight and obese status.2 The CDC defines overweight as a BMI equal to or greater than the 85th percentile to the 95th percentile for children of the same age and sex and obese as a BMI greater than the 95th percentile for children of the same age and sex.2 For the secondary outcome, we examined the demographics of all pediatric patients in the Ochsner Health System. Age, race, and sex of all current patients were documented. Pediatric patients were defined as any patient
